OBJECTIVES:Incidental diagnosis of pancreatic neuroendocrine tumors (PNETs) is increasing. Its surgical indication depends on the risk of progression, whereas histological features can be assessed by endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB). However, its systematic use remains a matter of debate. We aimed to analyze the impact of EUS-FNB on therapeutic management in patients with radiologically suspected PNETs. METHODS:In this retrospective observational single-center study, all patients with suspected PNET by radiological imaging who underwent EUS-FNB from 2011 to 2023 were enrolled. Patients with multiple endocrine neoplasia or previous/metastatic tumors were excluded. The North American Neuroendocrine Tumor Society (NANETS) consensus was followed, and modifications in management due to FNB findings were detailed. RESULTS:Of 212 patients undergoing EUS-FNB for suspected PNETs, 146 patients were included. No severe adverse events were reported during the biopsy procedure. Surgical pathology showed that the median tumor size was 17 mm, 32.2% were located in the pancreatic head. Therapeutic management was modified in 12 (8.2%) patients based on EUS-FNB findings due to different tumor types or additional high-risk tumor feature (n = 5), different tumor grading (n = 4), and absence of malignancy (n = 3). CONCLUSION:Systematic EUS-FNB improves accuracy in PNET diagnosis and is associated with a non-negligible rate of change in management. Large-scale studies are needed to confirm our findings.
OBJECTIVE:We aimed to assess the association of proton-pump inhibitor (PPI) use with muscle strength in older adults. METHODS:All 1940-born residents of Turku, Finland were surveyed during 2016 and 2017 as part of the New Turku Older Adults Study. Associations between PPI use, regardless of dosing pattern, and physical function were analyzed using Welch's t-test, chi-square test, and linear and logistic regression models. Models were initially run as crude, then adjusted for age, sex, and body mass index (Multivariable Model 1), and further adjusted for the Charlson Comorbidity Index (CCI) (Multivariable Model 2). RESULTS:Among 616 participants (63.1% females), PPI users had lower mean handgrip strength (27.6 kg vs. 30.1 kg, p = 0.019), slower median 4-m walking performance (3.7 s vs. 3.5 s, p = 0.017), and lower success in the armchair push-pull test (86.9% vs. 95.4%, p = 0.002) compared with non-users. Crude regression analyses showed poorer performance across all outcomes among PPI users (all p < 0.05); however, this persisted only for the armchair push-pull test through Multivariable Model 2 (odds ratio 0.40, 95% confidence interval 0.19-0.85, p = 0.02). In the sensitivity analysis, replacing the CCI with non-vitamin medication burden attenuated this association as well (p > 0.05). CONCLUSIONS:PPI use in older adults is significantly associated with lower muscle strength and poorer physical performance in less adjusted models, with these associations attenuating and disappearing with stepwise adjustment. These findings underscore the need to consider residual confounding in studies linking PPI use to adverse outcomes.
OBJECTIVES:We aimed to compare the clinical outcomes of the bent guidewire insertion (BGI) technique and the conventional straight guidewire insertion (SGI) technique for managing recurrent malignant biliary obstruction (RMBO) after initial uncovered metallic stent (UMS) placement. METHODS:Ninety patients who underwent endoscopic intervention for RMBO after UMS placement were retrospectively included. Clinical outcomes and endoscopic retrograde cholangiopancreatography (ERCP)-related factors were compared between the SGI and BGI groups. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors associated with difficult cannulation. RESULTS:There were 43 and 47 patients who underwent the SGI and BGI techniques, respectively, for intervention of RMBO. The SGI group had significantly higher rates of difficult cannulation (48.8% vs. 19.1%, p = 0.006) and guidewire insertion technique transformation (44.2% vs. 4.3%, p < 0.001). Additionally, procedure time (49.7 min ± 23.4 min vs. 34.7 min ± 20.5 min, p = 0.002) and cannulation time (5.0 min vs. 4.0 min, p = 0.005) were longer in the SGI group. Technical and clinical success rates, procedure-related complications, and length of hospitalization were comparable between the two groups. Multivariate analysis revealed that SGI (odds ratio [OR] 4.682, 95% confidence interval [CI] 1.643-13.340, p = 0.004) and hilar biliary tract lesions (OR 3.673, 95% CI 1.236-10.915, p = 0.019) were identified as independent factors for difficult biliary cannulation. CONCLUSION:BGI technique may be superior to SGI approach for re-intervention in patients with RMBO after initial UMS placement.
OBJECTIVES:Although endoscopic interventions and surgery are both used for treating bening biliary-enteric anastomotic stricture (BEAS), their comparative efficacy, safety, and economic impact have not been established. We conducted this study to address that gap. METHODS:Patients who underwent endoscopic intervention or surgical treatment for benign BEAS at Changhai Hospital, The First Affiliated Hospital of Naval Medical University (Shanghai, China) from February 2013 to February 2024 were included. The primary end-point was stricture resolution rate. Secondary end-points included adverse events (AEs), length of hospital stay, and total hospitalization cost. RESULTS:There were 65 and 58 patients underwent endoscopic intervention and surgical treatment for benign BEAS, respectively. The stricture resolution rate was lower in the endoscopic intervention group than in the surgical treatment group (78.5% vs. 93.1%, p = 0.024); however, endoscopic intervention achieved an ultimate stricture resolution rate of 90.8%. Endoscopic intervention had significantly lower rates of overall AE (9.2% vs. 27.6%, p = 0.01) and early AE (occurred within 30 days after surgery/endoscopic intervention) (4.6% vs. 25.9%, p = 0.002). In addition, endoscopic intervention resulted in a shorter length of hospital stay (10 days vs. 13 days, p = 0.013) and a lower hospitalization cost (CNY 24 355 vs. CNY 35 663, p < 0.001). CONCLUSIONS:In benign BEAS, surgery achieved a higher stricture resolution rate, whereas endoscopic intervention offered superior short-term outcomes, including shorter hospital stay, lower costs, and fewer AEs. Hence, we recommend initial endoscopic intervention with surgery reserved for nonresponders and recurrent cases.
OBJECTIVES:The universal adoption of endoscopic submucosal dissection (ESD) is limited by its technical demands, slow learning curve, long procedure time, and high risks of bleeding, muscular layer injury, and perforation. We developed the submucosal pressure ejection endoscopic dissection (SPEED) technique that combines pressure injection, incision, dissection, and coagulation and avoids frequent device exchange during ESD. We aimed to introduce this novel SPEED strategy and evaluate its therapeutic advantages for superficial gastrointestinal neoplasms. METHODS:Altogether 985 patients who underwent ESD for early gastrointestinal tumors between January 2020 and April 2024 were included and divided into the SPEED group and the conventional ESD group. Clinical outcomes, including en bloc and R0 resection rates, resection time, intraprocedural application of hemostatic forceps, procedure-related adverse events, and local recurrence, were evaluated. RESULTS:SPEED achieved en bloc and R0 resection rates of 99.85% and 99.40%, respectively. Compared with conventional ESD, SPEED was associated with a shorter median resection time (33 min vs. 57 min), less frequent intraprocedural application of hemostatic forceps (2.71% vs. 19.25%), a lower intraprocedural perforation rate (0.15% vs. 2.48%), and a lower post-procedure hemorrhage rate (1.51% vs. 5.90%). CONCLUSIONS:With the additional high-pressure injection, the SPEED technique greatly improves ESD efficiency and ensures a clearer visual field during ESD, thereby reducing risk of complications. It efficiently improves the speed and safety of dissection during ESD.
OBJECTIVE:To evaluate the clinical practice and quality of first-line Helicobacter pylori eradication therapy by gastroenterologists in direct-to-consumer telemedicine (DTCT) settings. METHODS:The study was conducted between November 2024 and February 2025 using unannounced standardized patients (USPs). Six trained and validated USPs questioned clinicians using specific H. pylori infection scenarios on hospital- or enterprise-sponsored DTCT platforms. Accessibility and effective consultation rates of the enquiry platforms were evaluated. The consultation process at each visit was also analyzed for guideline adherence and patient-centeredness. RESULTS:USPs conducted 552 visits on 53 hospital- and 19 enterprise-sponsored accessible platforms, with effective consultation rate of 65.6% (362 of 552). Based on a 10-point quality checklist, the overall guideline adherence score was 5.0, which was significantly higher for the enterprise-sponsored platforms than for hospital platforms (5.4 ± 2.7 vs. 4.8 ± 2.8, p = 0.045). When stratified by professional title of the clinicians involved, clinicians with intermediate title achieved a higher guideline adherence score than those with junior or senior titles (5.5 ± 2.7 vs. 4.3 ± 2.7 vs. 4.8 ± 2.8, p = 0.009). Altogether 72% of clinicians prescribed the correct treatment regimen for H. pylori infection. Furthermore, patient satisfaction during the treatment process was generally acceptable. CONCLUSIONS:We identified gaps in guideline adherence and clinical standardization for telemedicine-based H. pylori eradication in China. Further nationwide standardized training for gastroenterologists should prioritize structured history-taking, appropriate prescribing, resistance-guided antibiotic selection, and patient follow-up management. TRIAL REGISTRATION:ClinicalTrials.gov ID: NCT06749873.
OBJECTIVES:Despite the relatively comprehensive understanding of esophageal high-grade intraepithelial neoplasia (HGIN), clinical characteristics of HGIN dominated by cytological atypia after endoscopic submucosal dissection (ESD) remain unclear. We aimed to investigate the postoperative features and adverse events of patients with this pathological feature after ESD. METHODS:We retrospectively analyzed the data of 160 patients who underwent ESD for HGIN from 2018 to 2019. The patient cohort was divided into two groups based on the histopathology of the resected lesions: dominated by architectural atypia (HGINa) and cytological atypia (HGINc). Information on postoperative adverse events (fever, perforation, hemorrhage, and esophageal stricture) and second-stage endoscopic treatments was collected. Follow-up was conducted until December 2024 to analyze postoperative new-onset neoplasia between the two groups. Binary logistic regression analyses were used to assess risk factors for postoperative adverse events. RESULTS:Among all included patients, 43 (26.88%) and 117 (73.12%) were classified as having HGINc and HGINa, respectively. The rates of postoperative fever and new-onset neoplasia were significantly higher in the HGINc group than in the HGINa group (both p < 0.05), and HGINc emerged as an independent risk factor for these outcomes. Muscularis propria injury and mucosal defect exceeding 75% of the circumference were associated with postoperative esophageal stricture. CONCLUSION:Post-ESD management should focus on fever and new-onset neoplasia in patients with HGINc.
OBJECTIVES:To evaluate whether transcutaneous electrical acustimulation (TEA) during bowel preparation for small bowel capsule endoscopy (SBCE) can reduce the incidence of gastrointestinal adverse events (AEs), shorten gastric transit time (GTT), improve small bowel visualization quality, and enhance patient acceptability. METHODS:We prospectively enrolled outpatients scheduled for SBCE during December 2023 and March 2025. The participants were randomly allocated to receive either TEA at bilateral ST36 acupoints or sham stimulation (control) at non-acupoints during bowel preparation with split-dose polyethylene glycol. The primary outcome was the overall incidence of gastrointestinal AEs. Secondary outcomes included AE severity, small bowel visualization quality, GTT, and lesion detection rate, among others. RESULTS:A total of 39 participants completed the trial. Compared with the control group, TEA significantly reduced the overall incidence of gastrointestinal AEs during bowel preparation (p = 0.004), with particularly notable reductions in nausea and abdominal bloating. The overall severity of AEs was also markedly lower in the TEA group (p < 0.001). Furthermore, TEA significantly improved visualization quality scores for both the entire (p = 0.003) and distal small bowel (p = 0.030). GTT was significantly shorter in the TEA group (p < 0.001), and patient-reported scores for comfort (p = 0.027) and acceptability (p = 0.015) were significantly higher in the TEA group. CONCLUSIONS:TEA during SBCE bowel preparation significantly reduces gastrointestinal AEs, enhances small bowel visualization quality, and accelerates GTT. TEA is a safe and well-tolerated intervention, making it a promising adjunct to optimize SBCE.
OBJECTIVES:Vonoprazan was approved in China for reflux esophagitis (RE) in 2019; however, its real-world safety and effectiveness remain undetermined. We aimed to evaluate the safety of vonoprazan in patients and its effectiveness in patients with RE in a real-world setting. METHODS:In this prospective, non-interventional, real-world study, vonoprazan 20 mg was administered orally daily for 4 or 8 weeks. Primary endpoints were incidence rates of adverse events (AEs), serious AEs (SAEs), and adverse drug reactions (ADRs). Secondary endpoints included proportions of patients with RE without typical gastroesophageal reflux disease (GERD) symptoms (complete symptom relief) at baseline and Week 4, relief of heartburn/regurgitation symptoms (all day/nighttime) during Week 1, and mean change in GERD Questionnaire (GERDQ) score at Week 4. RESULTS:Of the 2829 patients with safety data, 488 (17.2%) reported ≥ 1 AE; 29 (1.0%) reported ≥ 1 SAE; and 129 (4.6%) reported ≥ 1 ADR. Of 1796 patients with RE and effectiveness data, the proportion without typical symptoms of GERD increased from 20.1% (95% confidence interval [CI] 18.29-22.05) at baseline to 55.2% (95% CI 52.63-57.79) at Week 4 (change: 35.1%, 95% CI 31.95-38.25). Complete relief from heartburn, nighttime heartburn, regurgitation, and nighttime regurgitation was observed in 32.3% (314/971), 43.8% (427/975), 27.0% (262/971), and 40.5% (395/976) patients, respectively, during Week 1. Mean change in GERDQ score (n = 1464) improved by Week 4 (-1.70). CONCLUSION:Vonoprazan is well tolerated through 8 weeks in patients and improves symptoms in patients with RE in the real-world setting in China (VIEW; NCT04501627).
Long-standing inflammatory bowel disease (IBD) increases the risk of dysplasia and colorectal cancer (CRC), particularly in patients with extensive disease or coexisting primary sclerosing cholangitis (PSC). Several non-conventional dysplasia subtypes have been identified. Hypermucinous dysplasia was first formally proposed in 2020, and it arises predominantly in patients with long-standing ulcerative colitis, frequently in extensive disease and concomitant PSC. Histologically, hypermucinous dysplasia is characterized by a tubulovillous or villous architecture lined by tall, prominent, mucin-rich epithelial cells comprising more than 50% of the lesion, with minimal-to-mild cytologic atypia. Although often classified as low-grade dysplasia according to previously established criteria, hypermucinous dysplasia is disproportionately associated with advanced neoplasia, including high-grade dysplasia and CRC, and frequently coexists with both conventional and other non-conventional dysplasias. Molecular alterations commonly include aneuploidy and occasional TP53 mutation. Emerging evidence suggests that non-dysplastic, mucin-rich epithelial proliferation, such as hypermucinous mucosa and foveolar metaplasia, may represent putative precursor lesions within a broader metaplasia-dysplasia sequence. This review provides the first comprehensive synthesis focusing exclusively on hypermucinous dysplasia, highlighting the consistency in histopathologic definitions, proposed precursor lesions, clinicopathological associations, molecular features, and diagnostic reproducibility. Increased awareness of hypermucinous dysplasia is essential for accurate diagnosis, risk stratification, high-risk IBD population screening, and optimal management of patients with IBD.
OBJECTIVES:Diagnosis of undifferentiated-type-predominant mixed-type early gastric cancer (UM-EGC) remains challenging due to its complex histological features and overlapping characteristics with other gastric cancer types. We aimed to develop a novel nomogram based on clinicopathological and endoscopic features and validate its performance in predicting UM-EGC prior to endoscopic treatment. METHODS:In this retrospective single-center study, 808 patients with early gastric cancer (EGC) who underwent curative endoscopic submucosal dissection were included. Among them, 493 were assigned to the training cohort and 84 to the external validation cohort. Clinicopathological characteristics and endoscopic features were compared between differentiated EGC and UM-EGC using logistic regression analysis. A predictive nomogram was constructed and evaluated. RESULTS:Multivariable regression analysis identified open-type atrophic gastritis (O1-O3) (odds ratio [OR] 0.25, 95% confidence interval [CI] 0.08-0.82), IIb (OR 9.72, 95% CI 3.01-31.35), IIc (OR 7.75, 95% CI 2.81-21.39), discolored lesion (OR 4.12, 95% CI 1.57-10.80), horizontal location at the greater curvature (OR 2.98, 95% CI 1.15-7.75) or anterior wall (OR 2.91, 95% CI 1.26-6.74), and previous H. pylori eradication (OR 0.23, 95% CI 0.09-0.55) as independently associated with UM-EGC. UM-EGC was also more susceptible to metachronous cancer (OR 5.50, 95% CI 1.30-23.21). The nomogram demonstrated good discriminative ability with an area under the receiver operating characteristic curve of 0.83 (95% CI 0.77-0.87) in the training cohort and 0.82 (95% CI 0.69-0.98) in the external validation cohort. CONCLUSION:This nomogram comprising clinicopathological and endoscopic features may assist in the preoperative prediction of UM-EGC risk. TRIAL REGISTRATION:The clinical trial registration number for patient source in this study is ChiCTR1800017117.
OBJECTIVE:To explore the involvement of neutrophil dysregulation in Cronkhite-Canada syndrome (CCS) and to identify serum biomarkers for its diagnosis and disease activity assessment. METHODS:We performed comprehensive serum proteomic analysis using data-independent acquisition (DIA) on samples from patients with active CCS (aCCS) and healthy controls (HCs). Candidate proteins were further evaluated by parallel reaction monitoring (PRM). An independent validation cohort including cases with aCCS, remitting CCS (rCCS), and HCs was then assessed using enzyme-linked immunosorbent assay (ELISA). In addition, previously generated transcriptomic data and immunofluorescence staining of colonic polyps were used to assess local neutrophil extracellular trap (NET)-related immune changes in intestinal tissues. RESULTS:Proteomic screening identified 362 differentially expressed proteins, and bioinformatic analysis consistently highlighted pathways related to neutrophil activation, acute inflammation, and NET formation. Key neutrophil-associated proteins, including myeloperoxidase (MPO), lipocalin-2 (LCN2), and matrix metalloproteinase-9 (MMP-9), were significantly upregulated. PRM validated seven upregulated candidate proteins. In the independent validation cohort, compared with HCs, serum MPO-DNA complexes, LCN2, and MMP-9 were significantly elevated in aCCS patients, whereas MPO-DNA complexes and MMP-9 were significantly reduced in rCCS cases. Tissue-level transcriptomic and immunofluorescence analyses further supported NET-related immune activation in CCS colonic polyps. Receiver operating characteristic curve analysis demonstrated favorable diagnostic performance for these biomarkers. CONCLUSIONS:Our findings support the involvement of neutrophil dysregulation and NET-associated pathways in CCS pathobiology. Serum MPO-DNA complexes, LCN2, and MMP-9 may serve as promising non-invasive biomarkers for diagnosis and disease activity monitoring. Further studies incorporating disease control cohorts and mechanistic validation are warranted.
OBJECTIVES:Gallstone disease (GSD), a prevalent digestive disorder, remains mechanistically underexplored in relation to visceral adipose. The Metabolic Score for Visceral Fat (METS-VF), a novel metric for quantifying visceral adipose tissue, has not yet been evaluated for its association with GSD in cohort studies. We aimed to investigate the METS-VF-GSD association across multicenter cohorts. METHODS:Multicenter cohort analysis of 59 851 participants from two Chinese hospitals and 357 233 participants from the UK Biobank dataset was conducted using Cox models to investigate the association between METS-VF and GSD risk. Competing risk models were also applied to the UK Biobank cohort. Meta-analysis and mediation analysis were used to synthesize results from the cohort analysis and evaluate mediation effects of inflammatory biomarkers. RESULTS:Cox models revealed a significant positive association between METS-VF and GSD risk, with a "J-shaped" nonlinearity, as confirmed by restricted cubic spline analysis (p < 0.05). Meta-analysis revealed that for each 1-unit and 1-standard deviation increase in METS-VF, GSD risk increased by 84% and 57%, respectively. Compared with participants in quantile 1 (Q1) of METS-VF, those in Q2 (pooled hazard ratio [HR] 1.65, 95% confidence interval [CI] 1.35-2.01), Q3 (pooled HR 2.16, 95% CI 1.83-2.54), and Q4 (pooled HR 3.00, 95% CI 2.82-3.19) were associated with progressively higher GSD risk. Mediation analysis revealed that certain inflammatory biomarkers partially mediated the effect of METS-VF on incident GSD. CONCLUSIONS:Increased METS-VF is associated with a higher risk of GSD. It may serve as an important indicator for identifying high-risk populations for GSD.
OBJECTIVE:To examine whether baseline levels and short-term changes of asymmetric dimethylarginine (ADMA) are associated with subclinical carotid atherosclerosis (SCA) and its progression in adults with metabolic dysfunction-associated steatotic liver disease (MASLD). METHODS:A total of 600 adults with MASLD were prospectively recruited and followed annually for 2 years. Serum ADMA was measured at baseline and 1-year follow-up. SCA, defined as increased carotid intima-media thickness or carotid plaque, was assessed at baseline, 1- and 2-year follow-up. Multivariable regression and propensity score-based analyses were performed to assess the associations between baseline ADMA or change in ADMA and SCA risk. RESULTS:Increased baseline ADMA level was significantly associated with SCA. Each 1-standard deviation (SD) increase in baseline ADMA was associated with higher odds of SCA (odds ratio 2.24, 95% confidence interval [CI] 1.66-3.01), with a dose-response relationship across ADMA quartiles. Baseline ADMA was not associated with SCA progression; however, dynamic increase in ADMA over time was strongly associated with SCA progression at both 1 and 2 years. Each 1-SD increase in absolute and relative changes of ADMA was associated with higher risks of SCA progression at 1 year (relative risk [RR] 1.82, 95% CI 1.60-2.07; RR 1.44, 95% CI 1.29-1.61) and 2 years (RR 1.52, 95% CI 1.36-1.70; RR 1.31, 95% CI 1.20-1.42). Associations were more pronounced among participants with pre-existing SCA. CONCLUSION:ADMA is associated with the prevalence of SCA, and short-term dynamic changes in ADMA may represent early indicators for SCA progression in adults with MASLD.
OBJECTIVE:To estimate the disability-adjusted life-years (DALYs) and incidence of vascular intestinal disease (VID) in individuals aged 65 years and above and identify its causal relationship with hypertension. METHODS:Analysis of VID burden focused on the incidence and DALYs in individuals aged 65 years and above. Socioeconomic inequalities were evaluated using the slope and concentration indices. Temporal trends of VID were evaluated with age-period-cohort (APC) modeling and Bayesian projections. Mendelian randomization (MR) analysis was employed to investigate the causal relationship between hypertension and VID. RESULTS:From 1990 to 2021, the global age-standardized DALYs rate (ASDR) and age-standardized incidence rate (ASIR) for VID declined, while the absolute number of incident cases increased. In 2021, the incident cases and DALYs reached 789 979 (95% uncertainty interval [UI] 615 343-978 593) and 1 116 683 (95% UI 996 036-1 210 921), with ASIR and ASDR of 105.59 per 100 000 (95% UI [82.43-130.50] per 100 000) and 151.66 per 100 000 (95% UI [134.58-164.67] per 100 000), respectively. Eastern Europe showed the highest DALYs rates. Bayesian APC projections indicated declining age-standardized rates but rising absolute numbers by 2040. MR analysis revealed hypertension as a significant causal risk factor for VID, with an odds ratio of 2.817 for inverse-variance-weighted and 3.618 for weighted median methods. CONCLUSION:Although VID burden remains high in high-income regions, its overall ASDR and ASIR have been declining. Meanwhile, hypertension is a causal factor for VID.
OBJECTIVES:Comparative data on infliximab (IFX) and tacrolimus as salvage therapies for intravenous glucocorticoid (ivGC)-refractory acute severe ulcerative colitis (ASUC) are limited. We aimed to evaluate the effectiveness and safety of IFX versus tacrolimus in hospitalized patients with ivGC-refractory ASUC. METHODS:This retrospective study was conducted between 2017 and 2024 at a tertiary medical center, including inpatients with ASUC who failed ivGC and received IFX or tacrolimus. The primary outcome was colectomy-free clinical response at discharge. RESULTS:Thirty-seven patients received IFX (median age 27 years; 32.4% males), and 24 received tacrolimus (median age 32 years; 41.7% males). Compared with the patients who received IFX, those receiving tacrolimus had a longer disease duration (4 years vs. 1 year, p = 0.031) and a higher rate of prior exposure to advanced therapy (anti-tumor necrosis factor agent: 58.3% vs. 2.7%, p = 1.05 × 10-6; Janus kinase inhibitors: 20.8% vs. 0%, p = 0.007). The length of hospitalization was significantly longer among those receiving tacrolimus (median 19.5 days vs. 11.0 days, p = 0.019). Colectomy-free clinical response rate at discharge (81.1% vs. 83.3%, multivariate analysis p = 0.956) and total colectomy rate in the following year (12.5% vs. 14.3%, p = 0.851) did not significantly differ between the IFX and tacrolimus groups. Safety profile during hospitalization was comparable between groups. CONCLUSIONS:In ivGC-refractory ASUC cases, IFX and tacrolimus showed comparable effectiveness and safety. Similar outcomes were observed despite a more treatment-refractory profile in the tacrolimus group. These findings support the use of either agent as a feasible salvage option in this clinical setting.
